05D0876177 CLIA NUMBER - CLINICA MEDICA VIRGEN DE GUADALUPE

Laboratory Demographics

  • CLIA Code: 05D0876177
  • Facility Name: CLINICA MEDICA VIRGEN DE GUADALUPE
  • Facility Address: 2955 E FLORENCE AVE
    HUNTINGTON PARK, CA
    ZIP 90255
  • Facility Phone: 323 585-0732
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LUIS A. GALDAMEZ MD
  • NPI Number: 1225168024
  • Taxonomy: 363A00000X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 05D0876177
LAB Type Physician Office
Facility Name CLINICA MEDICA VIRGEN DE GUADALUPE
Street 2955 E FLORENCE AVE
City HUNTINGTON PARK
State CA
ZIP 90255
Phone 323 585-0732
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2024
Certificate Expiration Date 3/6/2026
Facility Type Physician Office
Lab Director LUIS A. GALDAMEZ MD

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This page was last updated on: 9/29/2025